OBJECTIVETo investigate the causes of severe upper respiratory tract obstruction in neonates.

METHODSForty seven cases with severe dyspnea history were reviewed and retrospective analysis performed. Clinical manifestation, direct laryngoscope, CT, X-ray barium meal examination results and the treatment process were recorded.

RESULTSAmong 47 neonates, 41 cases were congenital diseases, accounting for 87.2% (41/47). In 41 cases, 15 cases were congenital laryngeal stridor, accounting for 31.9%, involving 6 cases accompanied by the gastroesophageal reflux. Fourteen cases were congenital upper respiratory tract cyst (10 cases of lingual root cyst, 3 cases of epiglottis cyst, 1 case of laryngeal cyst), accounting for 29.8%, in which 13 cases were misdiagnosis as congenital laryngeal stridor. Others were 6 cases of acute membrane laryngotracheobronchitis, 3 cases of congenital main respiratory tract stenosis, 2 cases of congenital laryngeal webs, 2 cases of vocal cord paralysis, 3 cases of Pierre Robin syndrome, 2 cases of Cri-du-chat syndrome. Except for 3 in 47 cases whose parents refused treatment, dyspnea in other 44 cases were relieved with inhaling oxygen and drug treatment, 37 case received tracheal intubation and sputum suction, 19 cases received direct laryngoscope or self-retaining laryngoscope operation.

CONCLUSIONSCongenital disease is the main cause of severe upper respiratory tract obstruction. For the neonates suffering from severe upper respiratory obstruction, finding out the cause and prompt treatment are essential for prognosis and reducing mortality.

Airway Obstruction ; etiology ; Congenital Abnormalities ; pathology ; Female ; Humans ; Infant, Newborn ; Male ; Retrospective Studies

OBJECTIVE: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. MATERIALS AND METHODS: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. RESULTS: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. CONCLUSION: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.
Abnormalities, Multiple ; Airway Obstruction/congenital/*pathology ; Ascites/pathology ; Diaphragm/abnormalities ; Female ; Fetal Diseases/*pathology ; Humans ; Lung/pathology ; *Magnetic Resonance Imaging ; Placenta Diseases/pathology ; Pregnancy ; *Prenatal Diagnosis ; Retrospective Studies